Cosmetic fillers do just what the name implies: they “fill” in the areas of the face that have lost volume due to age, gravity, and other environmental and genetic factors. In short, fillers are meant to rejuvenate skin and make it look younger by diminishing facial lines and creases while restoring tissue volume and fullness. Fillers can be used to plump thin lips, smooth the “laugh lines” around the mouth, augment the cheeks, and camouflage subtle facial skin asymmetries and irregularities. There are several different types of fillers available, varying by their chemical composition, degree of gel thickness, and anticipated duration of effects. The most common types of fillers I use are the hyaluronic acid (HA), poly-L-lactic acid, and calcium hydroxylapatite fillers. Hyaluronic Acid Fillers Hyaluronic acid (HA) is a naturally occurring substance found throughout the tissues of the body. The most popular and largest class of fillers, HA fillers like Juvederm, Voluma and Restylane provide immediate results. HA is inserted directly into the extracellular matrix of the body, which is a gel-like fluid in the spaces between our cells that offers support to our cells. When placed properly, HA fillers provide tissue support and increase tissue volume. It’s important to know that HA fillers differ in their thickness and anticipated duration of effects. In general, the thicker the filler, the deeper it is placed into the skin, leading to longer lasting results. For example, a thick HA filler like Voluma is best placed deeper into the jawline or cheek and can last up to two years, while a thinner HA filler like Restylane is better placed more superficially, or not as deeply, in the skin and into the thinner tissues of the face, such as the eyes and lips. Because of its thinner viscosity, Restylane is metabolized (absorbed by the body) within a year, with most results lasting between four and six months. Poly-L-lactic Acid Fillers In contrast to immediately effective HA fillers, poly-L-lactic acid fillers achieve results subtly over time by stimulating the body’s natural production of collagen, which is the protein in skin that keeps us looking young. Sculptra is the only poly-L-lactic acid filler available in the United States; it’s made of the same synthetic compound plastic surgeons have used for years in varying surgeries. Unlike other gel-like fillers, Sculptra comes as a powder that is reconstituted with sterile water before injecting. Most patients require three treatment sessions spaced over a few months so the injection fluid is not too concentrated, and the effects aren’t as dramatically noticeable right away. Typical Sculptra results can last for two years or more. Calcium Hydroxylapatite Fillers Calcium hydroxylapatite is a mineral-like compound found naturally in human bone that has been converted into a filler. Commonly known in the U.S. as Radiesse, this filler uses calcium hydroxylapatite particles to spur collagen growth. Due to its thicker character, it’s best used in deeper portions of the face, like the cheeks and nasolabial folds (the lines between the nose and mouth). Recently, Radiesse also received approval from the Food and Drug Administration (FDA) for use in hand rejuvenation, as it helps to hide the veins and tendons that become more noticeable with time. This particular filler should not be injected into the thin skin of the eyes or in the lips, as it can cause hard bumps or nodules. Results from a Radiesse injection can last anywhere from 9 to 15 months. While I like to give my patients a range of filler options depending on their cosmetic goals, I also remind them that fillers are just one way to keep their skin looking young. Replenishing lost tissue volume with fillers is certainly effective, but of equal importance is maintaining a good skincare regimen, including drinking water, applying moisturizer and sunblock, and using high quality facial products.